Kostman J R, Patel M, Catalano E, Camacho J, Hoffpauir J, DiNubile M J
Department of Medicine, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden, USA.
Clin Infect Dis. 1995 Nov;21(5):1159-65. doi: 10.1093/clinids/21.5.1159.
We describe three patients with advanced human immunodeficiency virus (HIV) infection, two with colitis and one with cholestatic hepatitis, for whom results of detailed endoscopic and histologic studies were suggestive of invasive spirochetosis. In the two patients with colitis, colonoscopic evaluation revealed either diffuse ulcerations or pustules; in both cases, there was histologic evidence of extensive superficial cell necrosis and infiltration of the mucosa and lamina propria with acute inflammatory cells. Spirochetes in the mucosa and crypts were visualized by Warthin-Starry silver staining. Morphologically similar spirochetes throughout the liver specimen from the patient with cholestatic hepatitis were demonstrated by Warthin-Starry silver staining. Analysis with electron microscopy revealed these organisms to be loosely coiled spirochetes. Despite extensive evaluation, no other pathogens were identified. Invasive spirochetal infection, as defined by the results of Warthin-Starry silver staining of involved tissues, should be considered in the differential diagnosis of patients with HIV infection who have otherwise unexplained colitis or cholestatic hepatitis.
我们描述了三名晚期人类免疫缺陷病毒（HIV）感染患者，其中两名患有结肠炎，一名患有胆汁淤积性肝炎，对他们进行的详细内镜和组织学研究结果提示存在侵袭性螺旋体病。在两名结肠炎患者中，结肠镜检查显示弥漫性溃疡或脓疱；在这两种情况下，组织学证据均显示广泛的浅表细胞坏死以及黏膜和固有层有急性炎症细胞浸润。通过Warthin-Starry银染色可在黏膜和隐窝中看到螺旋体。通过Warthin-Starry银染色在胆汁淤积性肝炎患者的整个肝脏标本中证实了形态相似的螺旋体。电子显微镜分析显示这些微生物是松散盘绕的螺旋体。尽管进行了广泛评估，但未发现其他病原体。对于患有无法解释的结肠炎或胆汁淤积性肝炎的HIV感染患者，在鉴别诊断中应考虑根据受累组织的Warthin-Starry银染色结果定义的侵袭性螺旋体感染。
